Detection of duodenal gastrinomas by operative endoscopic transillumination

Frucht, Harold; Norton, Jeffrey A.; London, Jerry F.; Vinayek, Rakesh; Doppman, John L.; Gardner, Jerry D.; Jensen, Robert T.; Maton, Paul N.

doi:10.1016/0016-5085(90)90466-e

Cited by 118 publications

(56 citation statements)

References 29 publications

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“…Results of EUS in detecting duodenal gastrinomas show sensitivities of only 50%. The generally small duodenal gastrinomas can be intraoperatively visualized in about 60–90% by palpation, transduodenal illumination and in all cases by direct exploration of the duodenum after duodenotomy [33, 34]. To find such small tumours, an exact surgical exploration of the duodenum, liver and pancreas must be performed in combination with intraoperative US and duodenal transillumination.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasonography of Neuroendocrine Tumours

et al. 2000

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Neuroendocrine tumours (NETs) of the upper gastrointestinal tract are mainly located in the pancreas, stomach or duodenum. The aims of preoperative work-up are the localization of primary tumour(s), determination of local tumour invasion, of lymph node metastases and of the hormones secreted by the tumour. Endoscopic ultrasonography (EUS) offers ideal conditions to localize and stage NETs of the foregut. We report our results in localizing and staging NETs of the foregut in 40 patients examined between 1990 and 1997 by EUS, somatostatin receptor scintigraphy (SRS), computed tomography (CT), magnetic resonance imaging (MRI) and transabdominal ultrasound (US). EUS shows the highest sensitivity in localizing insulinomas compared with SRS, US, CT and MRI. US and EUS should be the first-line diagnostics if insulinoma has been proven by a fasting test. Further diagnostic procedures are unnecessary in most cases. Further diagnostics such as CT or MRI to search for distant metastases are necessary in large tumours or local invasive tumours. EUS shows the highest accuracy to detect or exclude pancreatic gastrinomas, but fails to detect extrapancreatic gastrinomas in about 50%. The combination of EUS and SRS gives additional information. First-line diagnostics in gastrinoma patients should be SRS and CT or MRI. If no metastases are detected, EUS should be the next preoperative imaging procedure. In nonfunctional NETs, EUS provides the best information on local tumor invasion and regional lymph node involvement.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Ultrasonography of Neuroendocrine Tumours

et al. 2000

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“…Intraoperative ultrasound should be routinely used to assess and identify pancreatic lesions [35, 37, 38]. …”

Section: Diagnostic Procedures For Zes and Men1: Laboratory Tests Immentioning

confidence: 99%

“…Numerous localization studies have been recommended including conventional imaging studies (CT, MRI, ultrasound), selective angiography, functional localization methods (angiography with secretin stimulation for hepatic venous gastrin gradients, portal venous sampling for gastrin gradients), somatostatin receptor scintingraphy (SRS) and endoscopic ultrasound (EUS) as well as various intraoperative localization methods, including intraoperative ultrasound, intraoperative transillumination of the duodenum [35] and routine use of a duodenotomy [21, 33, 34,36,37,38,39]. Prospective studies show for primary gastrinomas that conventional imaging studies localize 10–40%, angiography 20–50% and SRS 60–70%.The use of SRS changes management in 15–45% of patients [33, 34, 40].…”

Section: Diagnostic Procedures For Zes and Men1: Laboratory Tests Immentioning

confidence: 99%

Gastrinoma (Duodenal and Pancreatic)

Jensen¹,

et al. 2006

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“…12,31,36,37 Briefly, palpation was performed after an extended Kocher maneuver and ultrasound with a 10-MHz real-time transducer was performed. 12 Since 1987, endoscopic transillumination of the duodenum was performed, 38 and a 3-cm longitudinal duodenotomy was centered in the anterolateral surface of the descending (second) duodenum to search for duodenal tumors. 12 After surgery, all patients had fasting serum gastrin levels and an secretin provocative test performed before discharge.…”

Section: Specific Protocolmentioning

confidence: 99%

Comparison of Surgical Results in Patients With Advanced and Limited Disease With Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

Norton

Alexander²,

Fraker³

et al. 2001

Annals of Surgery

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186

201

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ObjectiveTo determine the role of surgery in patients with Zollinger-Ellison syndrome (ZES) and multiple endocrine neoplasia type 1 (MEN1) with either limited or advanced pancreatic endocrine tumors (PETs). Summary Background DataThe role of surgery in patients with MEN1 and ZES is controversial. There have been numerous previous studies of surgery in patients with PETs; however, there are no prospective studies on the results of surgery in patients with advanced disease. MethodsEighty-one consecutive patients with MEN1 and ZES were assigned to one of four groups depending on the results of imaging studies. Group 1 (n ϭ 17) (all PETs smaller than 2.5 cm) and group 3 (n ϭ 8) (diffuse liver metastases) did not undergo surgery. All patients in group 2A (n ϭ 17; single PET 2.5-6 cm [limited disease]) and group 2B (n ϭ 31; two or more lesions, 2.5 cm in diameter or larger, or one lesion larger than 6 cm) underwent laparotomy. Tumors were preferably removed by simple enucleation, or if not feasible resection. Patients were reevaluated yearly. ResultsPancreatic endocrine tumors were found in all patients at surgery, with groups 2A and 2B having 1.7 Ϯ 0.4 and 4.8 Ϯ 1 PETs, respectively. Further, 35% of the patients in group 2A and 88% of the patients in group 2B had multiple PETs, 53% and 84% had a pancreatic PET, 53% and 68% had a duodenal gastrinoma, 65% and 71% had lymph node metastases, and 0% and 12% had liver metastases. Of the patients in groups 2A and 2B, 24% and 58% had a distal pancreatectomy, 0% and 13% had a hepatic resection, 0% and 6% had a Whipple operation, and 53% and 68% had a duodenal resection. No patient was cured at 5 years. There were no deaths. The early complication rate, 29%, was similar for groups 2A and 2B. Mean follow-up from surgery was 6.9 Ϯ 0.8 years, and during follow-up liver metastases developed in 6% of the patients in groups 2A and 2B. Groups 1, 2A, and 2B had similar 15-year survival rates (89 -100%); they were significantly better than the survival rate for group 3 (52%). ConclusionsAlmost 40% of patients with MEN1 and ZES have advanced disease without diffuse distant metastases. Despite multiple primaries and a 70% incidence of lymph node metastases, tumor can be removed with no deaths and complication rates similar to those in patients with limited disease. Further, despite previous studies showing that patients with advanced disease have decreased survival rates, in this study the patients with advanced tumor who underwent surgical resection had the same survival as patients with limited disease and patients without identifiable tumor. This suggests that surgical resection should be performed in patients with MEN1 who have ZES and advanced localized PET.

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Detection of duodenal gastrinomas by operative endoscopic transillumination

Cited by 118 publications

References 29 publications

Endoscopic Ultrasonography of Neuroendocrine Tumours

Endoscopic Ultrasonography of Neuroendocrine Tumours

Gastrinoma (Duodenal and Pancreatic)

Comparison of Surgical Results in Patients With Advanced and Limited Disease With Multiple Endocrine Neoplasia Type 1 and Zollinger-Ellison Syndrome

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